Lifestyle and Socioeconomic Transition and Health Consequences of Alzheimer's Disease and Other Dementias in Global, from 1990 to 2019.

BACKGROUND: Previous studies only focused on changes in the global age-specific incidence and mortality for Alzheimer's disease and other dementias, failed to distinguish between cohort and period effects, and did not discuss risk factors separately. METHODS: In this study, Alzheimer's disease disability-adjusted life years (DALYs) data to estimate the burden by gender, age, locations, and social-demographic status for 21 regions from 1990 to 2019. Additionally, trend analysis was performed using the age-period-cohort (APC) model and Join-point model. RESULTS: In most regions, indicators (incidence, mortality, and DALYs) increased steadily with socio-demographic index(SDI) increased. The age effects for Alzheimer's disease and other dementias showed a significant increase from 40 to 95 years. The cohort effects rate ratios (RRs) had a rapid reduction attributed to smoking, high fasting plasma glucose, and high body mass index (BMI). CONCLUSIONS: Countries in middle-low and low SDI regions have higher levels of risk factor exposure. As a result, rapid and effective government responses are necessary to control dementia risk factors and reduce the disease burden in these countries.

[A multicenter study to test the reliability and validity of the frailty assessment scale for elderly patients with inguinal hernia and to evaluate the value of clinical application].

Objectives: To verify the reliability and validity of the frailty assessment scale for elderly patients with inguinal hernia and to evaluate the value of its clinical application. Methods: A convenience sampling method was used to collect 129 geriatric patients who underwent inguinal hernia surgery from January 2018 to January 2023 in nine hospitals in Liaoning Province. There were 120 males and 9 females, of whom 89 patients were 60 to <75 years old, 33 patients were 75 to <85 years old and 7 patients were ≥85 years old. The 129 patients included 11 elderly patients with inguinal hernia who had recovered from preoperative infection with COVID-19. Statistical methods such as Cronbach's coefficient, Kaiser-Meyer-Olkin test, Bartlett's test, Pearson's correlation analysis, etc. were calculated to verify the reliability indexes such as feasibility, content validity, structural validity, criterion-related validity, internal consistency reliability, and re-test reliability. Taking the 5-item modified frailty index (5-mFI) as the gold standard, the area under the curve was used to analyze the ability of the two scales to predict the occurrence of postoperative acute urinary retention, postoperative delirium, poor incision healing, operative hematoma seroma, and postoperative complications. Results: The frailty assessment scale for elderly patients with inguinal hernia showed good reliability and validity (valid completion rate of 99.2%; item content validity index of 1.000, and the scale content validity index of 1.000; exploratory factor analysis extracted a total of 1 principal component, and factor loadings of each item of 0.565 to 0.873; the AUC for frailty diagnosis using 5-mFI as the gold standard of 0.795 (P<0.01) Cronbach's coefficient of 0.916, retest reliability coefficient of 0.926), it could effectively predict postoperative acute urinary retention, delirium, hematoma seroma in the operative area and total complications (AUC of 0.746, 0.870, 0.806, and 0.738, respectively; all P<0.05), and prediction efficiency was higher than that of 5-mFI (AUC of 0.694, 0.838, 0.626 and 0.641, P<0.05 for delirium only), but both scales were inaccurate in predicting poor incision healing (AUC of 0.519, P=0.913 for the frailty assessment scale and 0.455, P=0.791 for the 5-mFI). Conclusions: The frailty assessment scale for elderly patients with inguinal hernia is reliable and significantly predicts the occurrence of postoperative adverse events in elderly inguinal hernia patients. The scale can also be used for preoperative frailty assessment in elderly patients with inguinal hernia after rehabilitation from COVID-19 infection.

[Predictions of achievement of Sustainable Development Goal to reduce age-standardized mortality rate of four major non-communicable diseases by 2030 in China].

Objective: To predicate whether China can achieve the United Nations Sustainable Development Goals (SDGs) 3.4.1 to reduce the age-standardized mortality rate of four major non-communicable diseases (NCDs) in residents aged 30-70 years by 2030 based on the trend of the mortality from 1990 to 2019. Methods: We collected the mortality data on cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes by age, gender and year in China from the Global Disease Burden Study 2019 (GBD2019). The age-period-cohort (APC) Bayesian model was applied for modeling the age-standardized mortality rate of four major NCDs in China during 2020-2030 according to the trend of the mortality during 1990-2019, and comparing the predicted value in 2030 with the observed value in 2015 to evaluate the possibility of achieving SDGs 3.4.1. Results: The age-standardized mortality rate of the four major NCDs in China showed a downward trend during 1990-2019. It is predicted that the number of death of the four NCDs in Chinese residents aged 30-70 years would increase from 2.96 million in 2020 to 3.19 million in 2030, while the age-standardized mortality rate would decrease from 308.49/100 000 in 2020 to 277.80/100 000 in 2030. The age-standardized mortality rate in 2030 would only decrease by 15.94% (18.73% for males and 14.31% for females) compared with 330.46/100 000 in 2015, with a 25.09% decrease for cardiovascular diseases, 4.76% for cancers, 37.21% for chronic respiratory diseases, and unchanged for diabetes. Conclusion: Although the age-standardized mortality rate of four major NCDs declined from 1990 to 2019 in China, it is difficult to achieve the SDGs of a 1/3 mortality rate reduction by 2030 according to the current declining trend, suggesting more active and effective efforts for NCD prevention and control are needed.

[Investigation of the screening interval for population with negative colonoscopy examinations].

Objective: To investigate the colonscopy screening interval among patients with negative colonscopy. Methods: We selected 14 606 participants who completed the baseline and 3-year or 5-year colonoscopy examinations in the American Prostate, Lung, Colorectal, and Ovarian (PLCO) dataset as the target population. Sociodemographic characteristics (i.e., sex, age, marital status, race, and smoking), lifestyle, family history of cancer, and family history of colorectal cancer were collected. Cochran-Armitage trend analysis was used to examine whether the rate of positive cases (colorectal cancer, advanced adenoma, adenoma, and hyperplastic polyp) was increased with the length of screening interval. We compared the differences in number of detected cases, positive rates, and proportions of 3-year and 5-year screening interval strategies using internal standardization method. Results: The age of the population was （61.9±5.2） years and over half of them were males (54.4%) and 46.2% had family cancer history. The mean screening interval between the first and second endoscopies was （1 639.1±320.9） days. A total of 1 716 cases had positive endoscopic findings. With the screening interval extended, rate of the screened positive cases was also increased (P for trend<0.001). After standardized by the internal standardized population (14 606), 17.99 and 11.57 colorectal cancer cases and 177.37 and 240.35 advanced adenoma cases were detected by 3-year and 5-year screening interval strategies, respectively. Conclusion: Based on the initial screening negative population of colonoscopy in the United States, the 3-year screening interval strategy could detect a relatively large number of colorectal cancer cases, but its health and economic evaluation needs to be further explored.

[Construction of disease assessment index of silicosis patients].

Objective: To explore the establishment of disease assessment index model in silicosis patients. Methods: In October 2018, 171 silicosis patients who were hospitalized from November 2014 to November 2015 were selected as the study subjects. According to the standard of death risk, the subjects were divided into two groups, including the group without death risk (153 cases) and the group with death risk (18 cases) . Through literature analysis and clinical experience, the variables related to silicosis were preliminarily screened. Multifactorial logistic regression analysis variables were used to analyze the relationship between the variables and the risk of death. The variables associated with the risk of death were selected as the final variables to establish the disease assessment index model. And the receiver operating characteristic (ROC) curve was used to evaluate the clinical application of the disease assessment index. Results: Five variables of Modified British Medical Research Council Respiratory Questionnaire (mMRC) , pulmonary function injury, pneumoconiosis stage, aggravation of the disease and complications were selected as the variables of the disease assessment index, and the assessment index score ranged from 1 to 11 points. The area under the ROC curve of disease assessment index was 0.747 (95%CI: 0.590-0.904) , which could better identify the death risk of silicosis patients. With the increase of disease assessment index score, the death risk of silicosis patients increased. When the cutoff value was 7, the sensitivity and specificity were 0.667 and 0.876, respectively, for the risk of death of silicosis patients. The results of cross-validation showed that the correct discrimination rate of the disease assessment index to the risk of death was 66.7%. Conclusion: The disease assessment index can predict the death risk of patients with silicosis, and can evaluate the disease comprehensively.

Breast Cancer Found Incidentally After Reduction Mammaplasty in Young Insured Women.

BACKGROUND: Reduction mammaplasty is a common operation performed for healthy women. The estimated incidence of breast cancer diagnosed at the time of reduction mammaplasty varies from 0.06 to 4.5%, and information on the care of these patients is limited. This study aimed to determine the incidence of breast cancer identified incidentally during reduction mammaplasty and to characterize preoperative imaging. METHODS: Women 18 years of age or older who underwent reduction mammaplasty from 2013 to 2015 were identified from the Truven Health MarketScan® Research Databases. Patients with prior breast cancer were excluded. Descriptive statistics were calculated for patient characteristics, incidental breast cancer, preoperative breast imaging, and postoperative treatment. RESULTS: Reduction mammaplasty was performed for 18,969 women with a mean age of 42.5 years. Of these patients, 186 (0.98%) were incidentally found to have breast cancer, with 134 (0.71%) having invasive breast cancer and 52 (0.27%) having carcinoma in situ. The patients with incidentally found cancer were older than the patients without cancer (50.8 vs. 42.5 years; p < 0.001). Overall, 58.2% of the patients had undergone mammography before reduction mammoplasty. The rates were higher (> 80%) for the patients older than 40 years. Preoperative mammography was performed for 76.3% of those with a diagnosis of breast cancer at time of reduction mammoplasty. CONCLUSIONS: Breast cancer diagnosed incidentally at the time of reduction mammaplasty is uncommon and often radiographically occult. The majority of women older than 50 years appropriately received preoperative mammography. These data can be used to manage patient expectations about the potential for the incidental diagnosis of breast cancer at reduction mammaplasty, even with a negative preoperative mammography.

The Seed Semipermeable Layer and Its Relation to Seed Quality Assessment in Four Grass Species.

The existence of a semipermeable layer in grass seeds has been extensively reported, yet knowledge of its influence on tests for seed viability and vigor that depend upon measurement of electrical conductivity (EC) is limited. This study determined the presence and location of the semipermeable layer, and its relation to seed viability and vigor assessment, in seeds of four important grass species-Elymus nutans Griseb., Lolium perenne L., Leymus chinensis (Trin.) Tzvel., and Avena sativa L. Intact seeds of E. nutans, Lolium perenne, and Leymus chinensis exhibited little staining with triphenyl tetrazolium chloride (TTC), and there were no differences in EC between seeds with different germination percentage (GP) (P > 0.05). After piercing the seed coat, however, all three species displayed positive staining with TTC, along with a significant negative correlation between EC and GP (E. nutans: R2 = 0.7708; Lolium perenne: R2= 0.8414; Leymus chinensis: R2 = 0.859; P < 0.01). In contrast, both intact and pierced seeds of A. sativa possessed a permeable seed coat that showed positive staining with TTC and EC values that were significantly negatively correlated with GP [R2 = 0.9071 (intact) and 0.9597 (pierced); P < 0.01]. In commercial seed lots of A. sativa, a field emergence test indicated that EC showed a significant negative correlation with field emergence at two sowing dates (R2= 0.6069, P < 0.01 and 0.5316, P < 0.05). Analysis of seed coat permeability revealed the presence of a semipermeable layer located in the seed coat adjacent to the endosperm in E. nutans, Lolium perenne, and Leymus chinensis; however, no semipermeable layer was observed in A. sativa. This is the first report of the absence of a semipermeable layer in a grass species. The existence of a semipermeable layer is one of the most important factors affecting seed viability and vigor testing (based on EC measurement) in E. nutans, Lolium perenne, and Leymus chinensis. Increasing the permeability of the semipermeable layer, e.g., by piercing the seed coat, may permit the use of EC measurement to assess seed vigor in species that possess such a layer.

[Cost-effectiveness of multiple screening modalities on breast cancer in Chinese women from Shanghai].

Objective: To determine the most cost-effective modality for breast cancer screening in women living in Shanghai. Methods: A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district, Shanghai, during 2008 to 2012. Parameters of the model were derived from literatures. General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years. Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality. Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness. Results: The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one. The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved, which were within the threshold of 2-3 times of local per capita Gross Domestic Product. Results from sensitivity analysis showed that, due to higher incidence rate of breast cancer in Shanghai, the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China. Conclusion: Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai, and thus be widely promoted in this population elsewhere.

Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men.

BACKGROUND: The carbohydrate-insulin model of obesity posits that habitual consumption of a high-carbohydrate diet sequesters fat within adipose tissue because of hyperinsulinemia and results in adaptive suppression of energy expenditure (EE). Therefore, isocaloric exchange of dietary carbohydrate for fat is predicted to result in increased EE, increased fat oxidation, and loss of body fat. In contrast, a more conventional view that "a calorie is a calorie" predicts that isocaloric variations in dietary carbohydrate and fat will have no physiologically important effects on EE or body fat. OBJECTIVE: We investigated whether an isocaloric low-carbohydrate ketogenic diet (KD) is associated with changes in EE, respiratory quotient (RQ), and body composition. DESIGN: Seventeen overweight or obese men were admitted to metabolic wards, where they consumed a high-carbohydrate baseline diet (BD) for 4 wk followed by 4 wk of an isocaloric KD with clamped protein. Subjects spent 2 consecutive days each week residing in metabolic chambers to measure changes in EE (EEchamber), sleeping EE (SEE), and RQ. Body composition changes were measured by dual-energy X-ray absorptiometry. Average EE during the final 2 wk of the BD and KD periods was measured by doubly labeled water (EEDLW). RESULTS: Subjects lost weight and body fat throughout the study corresponding to an overall negative energy balance of ∼300 kcal/d. Compared with BD, the KD coincided with increased EEchamber (57 ± 13 kcal/d, P = 0.0004) and SEE (89 ± 14 kcal/d, P < 0.0001) and decreased RQ (-0.111 ± 0.003, P < 0.0001). EEDLW increased by 151 ± 63 kcal/d (P = 0.03). Body fat loss slowed during the KD and coincided with increased protein utilization and loss of fat-free mass. CONCLUSION: The isocaloric KD was not accompanied by increased body fat loss but was associated with relatively small increases in EE that were near the limits of detection with the use of state-of-the-art technology. This trial was registered at clinicaltrials.gov as NCT01967563.

Financial burden on the families of patients with hepatitis B virus-related liver diseases and the role of public health insurance in Yunnan province of China.

OBJECTIVE: To investigate the financial burden of patients who had various stages of hepatitis B virus-related diseases and the level of alleviation from financial burden by health insurance schemes in Yunnan province of China. STUDY DESIGN: A cross-sectional survey. METHODS: Patients' information was consecutively recorded at the First Affiliated Hospital of Kunming Medical University, from December 2012 to June 2013. Consecutive cases of hepatitis B virus (HBV) (520), compensated cirrhosis (91), decompensated cirrhosis (198) and hepatocellular carcinoma (HCC) (131) were recruited from the outpatient and inpatient departments. The total direct costs, hospital charge, outpatient costs, hospitalization fees being reimbursed and household catastrophic health expenditure were estimated for each disease group. RESULTS: The average annual direct costs for each disease group were 19,496 RMB for HBV, 28,466 RMB in compensated cirrhosis, 46,061 RMB for decompensated cirrhosis, and 33,044 RMB for HCC patients. Catastrophic health expenditure occurred in all four groups. Health insurance reimbursement released the financial burden incurred by medical expenses of patients under a high level of household economic status. Public health insurance schemes helped the patients to various extents. CONCLUSIONS: Among these patient groups, direct costs represent a significant economic burden. Health expenditure and financing systems must be considered to prevent the increase of household catastrophe, particularly among the poor.

Voluntary exercise prior to traumatic brain injury alters miRNA expression in the injured mouse cerebral cortex

MicroRNAs (miRNAs) may be important mediators of the profound molecular and cellular changes that occur after traumatic brain injury (TBI). However, the changes and possible roles of miRNAs induced by voluntary exercise prior to TBI are still not known. In this report, the microarray method was used to demonstrate alterations in miRNA expression levels in the cerebral cortex of TBI mice that were pretrained on a running wheel (RW). Voluntary RW exercise prior to TBI: i) significantly decreased the mortality rate and improved the recovery of the righting reflex in TBI mice, and ii) differentially changed the levels of several miRNAs, upregulating some and downregulating others. Furthermore, we revealed global upregulation of miR-21, miR-92a, and miR-874 and downregulation of miR-138, let-7c, and miR-124 expression among the sham-non-runner, TBI-non-runner, and TBI-runner groups. Quantitative reverse transcription polymerase chain reaction data (RT-qPCR) indicated good consistency with the microarray results. Our microarray-based analysis of miRNA expression in mice cerebral cortex after TBI revealed that some miRNAs such as miR-21, miR-92a, miR-874, miR-138, let-7c, and miR-124 could be involved in the prevention and protection afforded by voluntary exercise in a TBI model.

Determinants of sedentary 24-h energy expenditure: equations for energy prescription and adjustment in a respiratory chamber.

BACKGROUND: Achieving energy balance is critical for the interpretation of results obtained in respiratory chambers. However, 24-h energy expenditure (24EE) predictions based on estimated resting metabolic rate and physical activity level are often inaccurate and imprecise. OBJECTIVE: We aimed to develop and validate equations to better achieve energy balance in a respiratory chamber by adding or subtracting food items. DESIGN: By using a randomized data set with measures of 24EE (n = 241) performed at the Pennington Biomedical Research Center, we developed equations to predict 24EE from anthropometric, demographic, and body composition variables before and at 3 and 7 h into the chamber measurement. The equations were tested on an independent data set (n = 240) and compared with published predictive equations. RESULTS: By using anthropometric and demographic variables, the equation was as follows: 24EE (kcal/d) = 11.6 [weight (kg)] + 8.03 [height (cm)] - 3.45 [age (y)] + 217 (male) - 52 (African American) - 235. The mean prediction error was -9 ± 155 kcal/d (2046 ± 305 compared with 2055 ± 343 kcal/d for measured 24EE; P = 0.36). The prediction achieved a precision of ±10% of measured 24EE in 83% of the participants. Energy prescription was then refined by equations with the use of energy expenditure values after 3 h, 7 h, or both into the chamber study. These later equations improved the precision (±10% of measured 24EE) to 92% (P = 0.003) and 96% (P < 0.0001) of the participants at 3 and 7 h, respectively. Body composition did not improve 24EE predictions. CONCLUSIONS: We showed the use of a set of equations to prescribe and adjust energy intake to achieve energy balance in respiratory chambers over 24 h. These equations may be used in most respiratory chambers and modified to accommodate exercise or specific feeding protocols.

Clinical application and prognostic assessment of serum Tumor Associated Material (TAM) from esophageal cancer patients.

OBJECTIVE: To explore the correlation between serum levels of Tumor Associated Materials (TAM) and clinicopathological parameters and prognosis in patients with esophageal cancer (EC). PATIENTS AND METHODS: The levels of TAM were determined by chemical colorimetry in 100 EC patients and 100 healthy controls. RESULTS: Serum TAM levels were significantly higher in patients with esophageal carcinoma than in the control group (p < 0.001). High levels of TAM were associated with tumor size (p = 0.004), tumor depth (p < 0.001), stage (p < 0.001), lymph node metastases (p < 0.001), tumor differentiation (p = 0.001), tumor respectability (p = 0.002) and disease progression (p < 0.001). The poor prognostic outcomes were correlated with an elevated level of TAM (p = 0.001). Kaplan-Meier analysis showed patients with increased levels of TAM after operation had an lower overall survival (p < 0.001) and disease-free survival (p < 0.001). In addition, multivariate Cox proportional hazard analyses revealed that TAM may be an independent factor affecting the overall survival and disease-free survival (p < 0.001). CONCLUSIONS: The detection of TAM could be used to screen for tumor and assess unfavorable prognosis in patients with EC.

Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs.

AIMS: To assess associations between hypoglycaemia and risk of accidents resulting in hospital visits among people with type 2 diabetes receiving antidiabetes drugs without insulin. METHODS: People with type 2 diabetes who were not treated with insulin were identified from a US-based employer claims database (1998-2010). Following initiation of an antidiabetes drug, the occurrence of accidents resulting in hospital visits was compared between people with, and without, claims for hypoglycaemia using multivariable Cox proportional hazard models adjusted for demographics, comorbidities, prior treatments and prior medical service use. Additional analyses were stratified by age 65 years or older. RESULTS: A total of N = 5582 people with claims for hypoglycaemia and N = 27,910 with no such claims were included. Accidents resulting in hospital visits occurred in 5.5 and 2.8% of people with, and without, hypoglycaemia, respectively. After adjusting for baseline characteristics, hypoglycaemia was associated with significantly increased hazards for any accident [hazard ratio (HR) 1.39, 95% CI 1.21-1.59, p < 0.001], accidental falls (HR 1.36, 95% CI 1.13-1.65, p < 0.001) and motor vehicle accidents (HR 1.82, 95% CI 1.18-2.80, p = 0.007). In age-stratified analyses, hypoglycaemia was associated with greater hazards of driving-related accidents in people younger than age 65 and falls in people aged 65 or older. CONCLUSIONS: In people with type 2 diabetes receiving antidiabetes drugs without insulin, hypoglycaemia was associated with a significantly higher risk of accidents resulting in hospital visits, including accidents related to driving and falls.

Difficulties in organ procurement and transplantation in the aboriginal minority people in Taiwan.

BACKGROUND: Aboriginal people (AP) are a minority group in Taiwan. Little information on their perspectives on organ transplantation (OT) is available. Their rights for organ donation (OD) and as OT recipients (OTR) are constrained as a vulnerable population in society. This research sought to explore various Highland Aborigine Tribes beliefs systems and concepts related to OT. METHODS: We employed a qualitative design on a purposive sample including seven categories of Taiwanese AP. Data collected by face-to-face interviews were evaluated by content analysis. RESULTS: Seventy-five informants (45 female and 30 males) of 18 to 82 years from seven tribes completed interviews: Bunun (n = 20), Shao (n = 18), Tsou (n = 15), Amis (n = 12), Truku (n = 4), Rukai (n = 3), and Puyuma (n = 3). Of there, 33% had no idea of OT. All informants reported lack of knowledge of OD, organ procurement, and OTR. Eighty percent (45-82 years) had no willingness for OD or OTR; others might consult family members and health professionals (HP) to learn about OT. Seven hindering factors were identified: (1) having no background of OT; (2) limited impressions obtained from television news reports; (3) negative concepts of donating one's organs to others; (4) OT concepts contrast with cultural meanings of death; (5) possibility of being stigmatized; (6) fear of being rejected by others; and (7) HP had never mentioned OT. CONCLUSIONS: Taiwan APs' perspectives of OT concepts showed the majority to be unfamiliar with the concept and benefits of OT. Future research is necessary to explore the possible avenues to facilitate communications between HP and AP leaders, as well as elders in each AP category in Taiwan.

Identification of novel CHD1-associated collaborative alterations of genomic structure and functional assessment of CHD1 in prostate cancer.

A clearer definition of the molecular determinants that drive the development and progression of prostate cancer (PCa) is urgently needed. Efforts to map recurrent somatic deletions in the tumor genome, especially homozygous deletions (HODs), have provided important positional information in the search for cancer-causing genes. Analyzing HODs in the tumors of 244 patients from two independent cohorts and 22 PCa xenografts using high-resolution single-nucleotide polymorphism arrays, herein we report the identification of CHD1, a chromatin remodeler, as one of the most frequently homozygously deleted genes in PCa, second only to PTEN in this regard. The HODs observed in CHD1, including deletions affecting only internal exons of CHD1, were found to completely extinguish the expression of mRNA of this gene in PCa xenografts. Loss of this chromatin remodeler in clinical specimens is significantly associated with an increased number of additional chromosomal deletions, both hemi- and homozygous, especially on 2q, 5q and 6q. Together with the deletions observed in HEK293 cells stably transfected with CHD1 small hairpin RNA, these data suggest a causal relationship. Downregulation of Chd1 in mouse prostate epithelial cells caused dramatic morphological changes indicative of increased invasiveness, but did not result in transformation. Indicating a new role of CHD1, these findings collectively suggest that distinct CHD1-associated alterations of genomic structure evolve during and are required for the development of PCa.

Some perspectives on affordable healthcare systems in China.

Consistent with the global population trend, China is becoming an aging society. Over one-fifth of the world's elderly population (aged 65 and over) lives in China. Statistics show that the elderly populace in China constitutes 8% of the total population in 2006 and the percentage will be tripled to become 24% in 2050. As a result, there is inevitably an increase in the prevalence of chronic disease that accounted for almost 80% of all deaths in China in 2005. On the other hand, from 1978 to 2003, the total expenditure on healthcare in China increased from 11.02 billion RMB up to 658.41 billion RMB, and in terms of GDP, it is an increase from 3.04% to 5.62%. The annual average increase (12.1%) in healthcare investment is therefore even higher than the annual rate of GDP increase (9.38%) during the last two decades. Meeting the long-term healthcare needs of this growing elderly population and escalating healthcare expenditure pose a grim challenge to the current Chinese healthcare system and the solvency of state budgets. In fact, the healthcare services in China have become less accessible since the early 1980s when its costs soared up. The rising costs have prevented many Chinese people from seeking early medical care. The phenomenon has created a wide disparity in seeking healthcare between urban and rural areas. These trends are of particular concern to the elderly, who have higher healthcare needs yet lesser means to afford the services. Furthermore, according to the 3rd National Health Service Survey, 79.1% of rural residents and 44.8% of urban citizens did not have any form of medical insurance. Such a low percentage of coverage of medical insurance indicates that many people may not be able to afford medical services when they suffer from severe diseases. Therefore, there is a great need of a more effective and low-cost healthcare system. A new system that can allow multi-level, multi-dimensional and standardized healthcare services for urban and rural citizens is proposed based on the development of miniaturized, integrated, networked, digitalized, and smart (MINDS) medical devices. Different from the traditional healthcare systems, the new one should bridge individuals and hospitals through a four-layer (PHCH) system structure: wearable intelligent sensors and devices for p-Healthcare system (PHS), home healthcare system (HHS), community healthcare system (CHS), and hospital health information system (H2IS). This four-layer structure should ensure people be monitored by the new system as closely as it can, resulting in the novel transformation of the function of healthcare systems from symptoms treatment to early risk detection and prevention. The new system is of particular importance to the cost reduction of healthcare services. It can reduce the chance of individual providers taking advantage of the provider-patient information asymmetry to prescribe unnecessary or inappropriate (but profitable) care. It also allows people to self-monitor their health conditions at their convenience in an attempt to lighten the workload of doctors and nurses. Moreover, more people can benefit from the new system with much lower medical insurance fees due to the reduced risk of developing severe diseases through regular, long-term and effective monitoring of citizens' health conditions nation-wide.

Estimation of amino acid residue substitution rates at local spatial regions and application in protein function inference: a Bayesian Monte Carlo approach.

The amino acid sequences of proteins provide rich information for inferring distant phylogenetic relationships and for predicting protein functions. Estimating the rate matrix of residue substitutions from amino acid sequences is also important because the rate matrix can be used to develop scoring matrices for sequence alignment. Here we use a continuous time Markov process to model the substitution rates of residues and develop a Bayesian Markov chain Monte Carlo method for rate estimation. We validate our method using simulated artificial protein sequences. Because different local regions such as binding surfaces and the protein interior core experience different selection pressures due to functional or stability constraints, we use our method to estimate the substitution rates of local regions. Our results show that the substitution rates are very different for residues in the buried core and residues on the solvent-exposed surfaces. In addition, the rest of the proteins on the binding surfaces also have very different substitution rates from residues. Based on these findings, we further develop a method for protein function prediction by surface matching using scoring matrices derived from estimated substitution rates for residues located on the binding surfaces. We show with examples that our method is effective in identifying functionally related proteins that have overall low sequence identity, a task known to be very challenging.

Toxicity assessment of polycyclic aromatic hydrocarbons using an air-tight algal toxicity test.

The existing toxicity data on the effects of polycyclic aromatic hydrocarbons (PAHs) on Pseudokirchneriella subcapitata (green alga) are quite insufficient. These data were derived using different test techniques (e.g. conventional batch test, closed-system test, semi-static test). The relative toxicity relationship for various PAHs is thus difficult to interpret. Consequently, the current toxicity database is insufficient and also inadequate for analyses of the effects of PAHs on P. subcapitata. This study evaluated the toxicity of eleven PAHs using an air-tight test technique. The relative toxicity relationship was determined on a uniform basis, and was different from the relationship based on current available data. P. subcapitata. was found to be more susceptible to PAHs than Daphnia magna, fathead minnow, and Scenedesmus subspicatus. Quantitative structure-activity relationship (QSAR) was established based on the chemical's hydrophobicity with R(2) equal to 0.88. Photo-induced toxicity for various PAHs was also explored by exposing PAHs under UV-photoactivation. Toxicity of anthracene, benzanthrone, and benzo[a]anthracene was found to increase 3.5 to 25 times after UV exposure. Phototoxicity was observed when the HOMO-LUMO gap varied between 6.8 and 8.0 eV.

Vitamin B6 intakes and status assessment of elderly men and women in Taiwan.

Studies have indicated that vitamin B6 status decreases with age. However, little is known about vitamin B6 status of elderly people in Taiwan. The purpose of this study was to assess vitamin B6 status of elderly Taiwanese and to examine the effect of protein on various indices of vitamin B6 status in the elderly. Thirty-nine men (mean age = 69.9 +/- 4.2 years) and 55 women (mean age = 69.5 +/- 3.9 years) completed a 24-h diet recall. The mean total vitamin B6 intake (men: 1.7 +/- 0.9 g/day; women: 1.6 +/- 1.2 g/day) was higher than the 1998 US Dietary Reference Intakes (DRI) and the current Taiwan Recommended Daily Nutrient Allowance (RDNA). Dietary energy and protein intakes were not related to any vitamin B6 status parameters in any sex groups and the pooled group. Vitamin B6 intake correlated only with erythrocyte aspartate transaminase activity coefficient (EAST-AC) in the pooled (r = -0.214, p < 0.05) group. There were no significant differences in plasma pyridoxal 5'-phosphate (PLP), erythrocyte alanine transaminase activity coefficient (EALT-AC), and EAST-AC between sex groups. Although elderly subjects had adequate mean plasma PLP concentrations, 59% of men and 55% of women had plasma PLP concentrations lower than a cutoff of 20 nmol/L. The mean EALT-AC was < 1.25 in two groups with adequate vitamin B6 status. However, 23% of men and 18% of women had EALT-AC values > 1.25. The mean EAST-AC value of subjects was higher than the suggested value (< 1.8) for inadequate vitamin B6 status. The incidence of biochemical vitamin B6 deficiency in our elderly is probably more relevant from other causes than from dietary intake of protein and vitamin B6.